decisionhealth Newsletters, Coder Pink Sheets - 2010 Issue 1 (January)
Noridian decides not to block coverage for facet injections
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Article Overview
This article explains a Medicare contractor’s decision to step back from a proposed noncoverage action involving facet joint injection services, while signaling that a future local coverage determination may still be developed. It is relevant to physicians, billing staff, and specialty groups monitoring Medicare coverage policy, documentation review, and payer activity affecting interventional pain procedures.
Why This Topic Matters
It helps readers track potential Medicare coverage changes that may affect reimbursement, compliance, and documentation review for facet-related procedures.
Article Sections
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Coverage update and contractor position
Summarizes the payer’s revised stance on the procedures and the general reasons cited for reconsidering the earlier proposal.
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Specialty society feedback and data collection
Describes the role of physician organizations and outcomes data in the contractor’s review process.
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Future local coverage determination plans
Outlines the expectation of additional local coverage activity and mentions the broader review issues identified by the contractor.
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Official resource
Provides the linked external payer announcement referenced by the article.
What You Will Learn
- The general Medicare coverage status of facet joint injection procedures.
- How specialty society input can influence payer policy review.
- Why future local coverage activity may still be relevant to billing and documentation teams.
- The kinds of policy concerns Medicare contractors may cite in evaluating these services.
Who Should Read This
- Physicians
- Pain management specialists
- Billing and coding professionals
- Compliance staff
- Practice managers
- Medical specialty societies
Codes Discussed
Code Ranges Discussed
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